Compagnon F, Zerdoud S, Rives M, Laprie A, Sarini J, Grunenwald S, Chaltiel L, Graff P
Département de radiothérapie, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
Département de médecine nucléaire, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
Cancer Radiother. 2016 Jul;20(5):362-9. doi: 10.1016/j.canrad.2016.05.010. Epub 2016 Jul 5.
To assess the outcome of locally advanced medullary thyroid carcinoma treated with surgery and adjuvant external beam radiotherapy.
Twenty-nine consecutive patients with non-metastatic medullary thyroid carcinoma treated in our institution between January 1995 and December 2012 were retrospectively evaluated. All underwent curative-intended optimal surgery, followed by external beam radiotherapy because of high risk of locoregional relapse. Twelve patients were stage III, 16 IVa and 1 IVb. Positive surgical margins were present in 11 cases (10 R1 and 1 R2). Median and average preradiotherapy serum calcitonin were 141pg/mL and 699pg/mL, respectively. Fourteen patients received 3D-conformal radiotherapy and 15 received intensity-modulated radiotherapy. Median prescribed dose was 63Gy to the high-risk volumes and 54Gy to the low-risk volumes. Treatment was delivered in 30 fractions. The median gap between surgery and radiotherapy was 1.9months. Median follow-up was 76.4months.
Kaplan-Meier estimates of 5-year locoregional relapse-free survival and overall survival were 79 and 96 %, respectively. Among the five locoregional relapses, two were related to a macroscopic metastatic cervical lymph node that was unfortunately not removed during the lymphadenectomy. Eight of ten patients with microscopic positive margins (R1) were controlled regarding the thyroidectomy bed. Eight patients had normal serum calcitonin after external beam radiotherapy, of whom only one developed a locoregional relapse during follow-up. Regarding the 21 patients with persistent positive serum calcitonin after treatment, only ten developed a macroscopic locoregional or distant relapse. One grade III and no grade IV acute morbidity were reported. Fifteen patients reported grade II chronic morbidity and no grade III/IV.
Maximal surgery followed by adjuvant external beam radiotherapy as a treatment for locally advanced medullary thyroid carcinoma provides a high rate of long-term locoregional control and overall survival with limited toxicity. Postoperative external beam radiotherapy should be considered when patients present features indicating a high risk of locoregional relapse.
评估手术联合辅助外照射放疗治疗局部晚期甲状腺髓样癌的疗效。
对1995年1月至2012年12月间在本机构接受治疗的29例连续非转移性甲状腺髓样癌患者进行回顾性评估。所有患者均接受了旨在治愈的最佳手术，由于局部区域复发风险高，术后接受了外照射放疗。12例患者为III期，16例为IVa期，1例为IVb期。11例（10例R1和1例R2）手术切缘阳性。放疗前血清降钙素中位数和平均值分别为141pg/mL和699pg/mL。14例患者接受了三维适形放疗，15例接受了调强放疗。高危靶区的中位处方剂量为63Gy，低危靶区为54Gy。治疗分30次进行。手术与放疗之间的中位间隔时间为1.9个月。中位随访时间为76.4个月。
5年局部区域无复发生存率和总生存率的Kaplan-Meier估计值分别为79%和96%。在5例局部区域复发中，2例与颈部淋巴结宏观转移有关，遗憾的是在淋巴结清扫术中未切除。10例显微镜下切缘阳性（R1）的患者中有8例甲状腺切除床得到控制。8例患者外照射放疗后血清降钙素正常，其中仅1例在随访期间出现局部区域复发。在治疗后血清降钙素持续阳性的21例患者中，仅10例出现宏观局部区域或远处复发。报告1例III级急性不良反应，无IV级。15例患者报告II级慢性不良反应，无III/IV级。
对于局部晚期甲状腺髓样癌，最大程度手术联合辅助外照射放疗可提供较高的长期局部区域控制率和总生存率，且毒性有限。当患者出现提示局部区域复发高风险的特征时，应考虑术后外照射放疗。
